<#assign regionSelectDirective="com.enation.app.shop.front.tag.goods.other.regions.RegionSelectDirective"?new()>

<style>
.input_text{
	width: 200px;
}
</style>

<div class="easyui-panel" style="border-style: none;">
	<div style="padding: 10px 0 10px 20px">
		<form id="dlyCenterForm" method="post" class="validate">
			<table>
				<tr>
					<th>发货点名称：</th>
					<td><input class="input_text easyui-validatebox" type="text" id="name" maxlength="20"
						name="name" data-options="required:true"
						style="width: 155px;"></input>
					</td>
					<th>发货人姓名：</th>
					<td><input class="input_text easyui-validatebox" type="text" id="url"  maxlength="20"
						name="uname" data-options="required:true"></input>
					</td>
				</tr>
				<tr>
					<th>地区：</th>
					<td>
						<@regionSelectDirective />
					</td>
					<th>手机：</th>
					<td><input class="input_text easyui-validatebox" type="text" validType="mobile"
						name="cellphone" maxlength="11"></input>
					</td>
				</tr>

				<tr>
					<th>邮编：</th>
					<td><input class="input_text easyui-validatebox" name="zip" onkeyup="this.value=this.value.replace(/\D/g,'')" 
					onafterpaste="this.value=this.value.replace(/\D/g,'')"
						maxlength="6">
					</td>
					<th>电话：</th>
					<td><input class="input_text easyui-validatebox" type="text" validType="tel"
						name="phone" maxlength="15"></input>
					</td>
				</tr>
				<tr>
					<th>地址：</th>
					<td><input class="input_text" type="text" maxlength="30"
						name="address"></input>
					</td>
					<th>默认地址：</th>
					<td><input type="checkbox" id="is_default_dc"  name="is_default"></input>
						<input type="hidden" name="choose"  id="dlyCenterDisabled"/>
					</td>
				</tr>

				<tr>
					<th>备注：</th>
					<td colspan="3"><textarea rows="5" cols="45" class="input_text" maxlength="100"
							style="width: 395px;" name="memo"></textarea></td>
				</tr>
			</table>
		</form>
	</div>
</div>
